A Gift Of TimeSenior Care Glossary
A to Z Reference of Senior Care Terms
Printed on:
Clear definitions of the terms, acronyms, and jargon you will encounter when researching senior living, caregiving, and long-term care options. Definitions are based on standard industry usage and publicly available resources.
Daily Care
13 termsADLs (Activities of Daily Living)
The fundamental self-care tasks that measure a person's functional ability. ADLs include bathing, dressing, eating, toileting, transferring (moving from bed to chair), and continence. The ability — or inability — to perform ADLs independently is the primary factor used to determine what level of care a senior needs and whether they qualify for long-term care insurance benefits or certain public assistance programs.
Adult Day Care
A supervised, structured daytime program for older adults who need assistance, supervision, or social engagement during the day but live at home with family caregivers. Adult day care centers typically operate Monday through Friday during business hours and provide a range of services including meals, social activities, exercise programs, medication management, personal care assistance, and sometimes transportation. Some centers specialize in serving adults with dementia, offering specialized activities and secured environments designed to reduce agitation and promote engagement. For family caregivers who work during the day, adult day care is often the critical service that allows them to maintain employment while keeping their loved one at home. In Wisconsin, adult day care may be covered by Family Care, Medicaid, and some long-term care insurance policies. The cost is typically a fraction of assisted living or nursing home care, making it one of the most cost-effective ways to delay or avoid institutional care. When evaluating adult day care centers, families should visit during program hours, observe the staff-to-participant ratio, ask about specialized dementia programming if needed, and confirm whether the center is licensed by the Wisconsin Department of Health Services.
Care Level / Tiered Pricing
The pricing model used by most assisted living communities in Wisconsin, where residents are assessed and assigned to a care level (often numbered 1 through 4 or 5) based on how much assistance they need with ADLs, medication management, and cognitive support. Each care level adds a monthly fee on top of the base rent — for example, Level 1 might mean the resident only needs medication reminders and standby shower assistance, while Level 4 might mean hands-on help with bathing, dressing, toileting, and mobility. Some communities use a points-based system where each service has a point value and the total points determine the monthly care fee. This is the single biggest source of unexpected costs for families: a community may quote an attractive base rate of $4,000, but after the nurse assessment places the resident at Level 3, the actual monthly cost could be $6,200. Always ask for a detailed written breakdown of exactly what each care level includes and what specific changes would trigger a move to the next level, and confirm how often care levels are reassessed (quarterly is common).
Caregiver Burnout
The physical, emotional, and mental exhaustion that results from the sustained demands of caring for a loved one with chronic illness, disability, or dementia. Caregiver burnout is characterized by overwhelming fatigue, anxiety, depression, withdrawal from friends and family, loss of interest in previously enjoyed activities, irritability, and neglect of one's own health needs. Family caregivers experiencing burnout often report feeling trapped, resentful, or guilty — and many ignore their own medical appointments, skip meals, and lose sleep while prioritizing their loved one's care. Burnout is particularly common among dementia caregivers, where the progressive nature of the disease means care demands increase over time while the emotional reward of reciprocal interaction diminishes. Warning signs include: getting sick more often, chronic exhaustion, changes in appetite or weight, loss of control over emotions, and thoughts of self-harm. Professional support — including respite care, caregiver support groups, individual therapy, and in some cases transitioning the loved one to a care community — is essential, not optional.
CCRC (Continuing Care Retirement Community)
A senior living campus that offers multiple levels of care — independent living, assisted living, memory care, and skilled nursing — on one property. The defining feature of a CCRC is the continuum: residents can transition between care levels as their health needs change without relocating to an unfamiliar community. Most CCRCs require a substantial upfront entry fee (often $100,000 to $500,000+) plus ongoing monthly fees. There are different contract types: Type A (Life Care) provides unlimited assisted living and skilled nursing with little to no increase in monthly fees; Type B (Modified) provides a set number of days of higher-level care included; Type C (Fee-for-Service) charges market rates for higher-level care as needed. CCRCs typically require both medical and financial screening. For couples with different care needs, a CCRC can be especially valuable.
CARF AccreditationHospice
A specialized model of care focused on providing comfort, dignity, and quality of life for people in the final months of a terminal illness — typically when a physician certifies that the patient has a life expectancy of six months or less if the disease follows its normal course. Hospice is not a place but a philosophy of care: it can be provided in a person's home, an assisted living apartment, a nursing home, or a dedicated hospice facility. The hospice team includes physicians, nurses, social workers, chaplains, certified nursing assistants, and volunteers who work together to manage pain and symptoms, provide emotional and spiritual support for both the patient and family, and help families navigate the practical and emotional challenges of end-of-life care. Hospice care is fully covered by Medicare Part A, Medicaid, and most private insurance with no out-of-pocket cost for the patient — including medications, medical equipment (such as hospital beds and wheelchairs), and supplies related to the terminal diagnosis. Importantly, choosing hospice does not mean giving up all medical care; it means shifting the focus from curative treatment to comfort and quality of life. A patient can leave hospice at any time if their condition improves or they choose to pursue curative treatment again. For families, hospice also provides 13 months of bereavement support after the patient's death, making it one of the most comprehensive and underutilized support systems available to seniors and their families.
NHPCO Hospice InfoIndependent Living
A senior housing option designed for older adults who are generally healthy, active, and able to live independently but prefer the convenience, social opportunities, and security of a community designed specifically for seniors. Independent living communities typically offer apartment-style housing with maintenance-free living, housekeeping services, meal plans, transportation, social activities, fitness centers, and 24-hour staff availability — but they do not provide personal care, medication management, or healthcare services. Independent living is the most autonomous of the senior living options and is best suited for seniors who do not need help with activities of daily living (ADLs) but want to downsize from a larger home, eliminate home maintenance responsibilities, and enjoy a built-in social community. Some independent living communities are part of a continuing care retirement community (CCRC), allowing residents to transition to assisted living or skilled nursing on the same campus as their needs change. In Wisconsin, independent living costs range from approximately $2,500 to $5,500 per month depending on location, amenities, and apartment size. Unlike assisted living or nursing homes, independent living is not covered by Medicare, Medicaid, or long-term care insurance — it is paid entirely out of pocket.
Medication Management
A paid service offered by most assisted living and memory care communities in which trained staff organize, administer, and monitor a resident's medications. Medication management typically includes ordering refills, verifying dosages, ensuring medications are taken on schedule, documenting each administration, and communicating with physicians and pharmacies about changes or interactions. It is nearly always billed as a separate monthly add-on — often $400 to $800 per month depending on complexity and the number of medications — on top of the base rent. Families comparing community costs should always ask for a written breakdown of medication management fees because two communities with identical base rent can diverge by thousands annually once medication services are added. This service is particularly critical for residents with multiple chronic conditions, cognitive impairment, or complex medication regimens where missed doses or drug interactions pose serious health risks.
Palliative Care
A medical specialty focused on relieving the symptoms, pain, and stress of serious illness — regardless of the prognosis or whether the patient is still receiving curative treatment. Unlike hospice, which is specifically for people with a terminal diagnosis of six months or less, palliative care can be provided at any stage of a serious illness and alongside curative treatments such as chemotherapy, radiation, or dialysis. The palliative care team — typically including physicians, nurses, social workers, and chaplains — works with the patient's existing doctors to manage symptoms like pain, shortness of breath, fatigue, nausea, loss of appetite, and sleep problems; coordinate care between multiple specialists; and help patients and families make complex medical decisions aligned with their values and goals. Palliative care is available in hospitals, outpatient clinics, nursing homes, and increasingly in the home. It is covered by Medicare, Medicaid, and most private insurance. Many families confuse palliative care with hospice, but the key distinction is that palliative care is appropriate at any stage of serious illness and does not require a terminal prognosis. For seniors with multiple chronic conditions, palliative care can significantly improve quality of life, reduce unnecessary hospitalizations, and help families navigate difficult care decisions before a crisis occurs.
Get Palliative CareRespite Care
Short-term, temporary relief care designed to give family caregivers a break from the daily demands of caring for a loved one. Respite care can be provided in the home by an in-home aide, at an adult day care center, or in a residential facility such as an assisted living community or nursing home for overnight or extended stays ranging from a few days to several weeks. The purpose is to prevent caregiver burnout by allowing the primary caregiver to rest, travel, attend to their own health needs, or simply recharge while knowing their loved one is receiving safe, professional care. Respite care is especially valuable for dementia caregivers, who face around-the-clock supervision demands and are at the highest risk of burnout. In Wisconsin, respite care may be covered through the Family Care program, IRIS, Veterans benefits, and some long-term care insurance policies. Some assisted living communities offer short-term respite stays as a way for families to trial the community before making a permanent move decision. The cost of respite care varies widely based on setting and level of care needed, but it is one of the most cost-effective investments a family can make in sustaining long-term caregiving.
Room and Board
The base monthly fee charged by assisted living communities, memory care facilities, and some independent living communities that covers the cost of the apartment, meals, utilities, housekeeping, and basic building maintenance. Room and board is the starting point of any assisted living cost comparison, but it does not include the care services that most residents need. Care services — such as medication management, assistance with bathing and dressing, and specialized dementia care — are typically billed as additional monthly fees based on the resident's care level or tier. When comparing communities, families should always ask for a complete written breakdown that separates room and board from care fees, medication management, and any other add-ons. Two communities with identical room and board rates can differ by thousands of dollars per month once care is factored in. In Wisconsin, room and board in assisted living typically ranges from $3,500 to $6,000 per month, while memory care room and board usually ranges from $5,000 to $8,000 per month before care fees are added.
Skilled Nursing Facility (SNF)
A residential facility licensed and regulated by both federal and state authorities that provides 24-hour nursing care, medical supervision, and rehabilitation services for people who need a higher level of care than assisted living can provide. SNFs are staffed by registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs) who provide medical care including wound care, IV therapy, medication administration, physical therapy, occupational therapy, and speech therapy. Medicare Part A covers up to 100 days of skilled nursing care per benefit period after a qualifying inpatient hospital stay of at least three consecutive midnights, but only for skilled medical care — not for custodial care when that is the only need. For long-term custodial care in a nursing home, Medicaid is the primary payer for low-income seniors, while long-term care insurance and private pay cover the rest. In Wisconsin, nursing homes are regulated by the Department of Health Services and undergo annual state surveys. Families choosing a nursing home should review the facility's Medicare star rating, most recent state survey results, staffing ratios, and specialized programs (such as dementia care or ventilator care). The average cost of a semi-private room in a Wisconsin nursing home is approximately $9,000 to $11,000 per month.
Transfer Trauma
A recognized phenomenon in geriatric care where a senior experiences significant disorientation, confusion, anxiety, depression, or physical decline following a major relocation — such as moving from a long-time family home to an assisted living or memory care community. Transfer trauma, also called relocation stress syndrome, is thought to result from the abrupt disruption of familiar routines, environments, and sensory cues that a person has relied on for orientation and comfort. Symptoms typically appear within the first two to four weeks after a move and can include confusion about location, withdrawal from social interaction, loss of appetite, sleep disturbances, increased falls, and refusal to participate in activities. The risk is highest for seniors with cognitive impairment, those who had little involvement in the decision to move, and those moving from a home they lived in for decades. Prevention strategies include arranging the new apartment to mirror the old one, visiting daily for the first week, introducing the senior to staff and residents by name on move-in day, and ensuring the senior arrives after the apartment is fully set up. Transfer trauma is usually temporary — most seniors adjust within a few weeks to a month with consistent family presence and staff support.
Wisconsin Programs
7 termsADRC (Aging and Disability Resource Center)
Wisconsin's county-level entry point for seniors and adults with disabilities seeking information about long-term care options. ADRCs provide free, unbiased guidance on programs like Family Care and IRIS, conduct functional eligibility screenings, and connect families with local resources. Every Wisconsin county has an ADRC.
Find your ADRCBadgerCare Plus
Wisconsin's name for its Medicaid program, which provides health insurance and long-term care coverage to eligible low-income residents. In the senior care context, BadgerCare Plus is the program through which Wisconsin administers Medicaid-funded long-term care services including nursing home care and, through managed care programs like Family Care and IRIS, assisted living and in-home care. Eligibility is based on income and asset limits, which vary by program category. For seniors, BadgerCare Plus is the gateway to Wisconsin's full range of long-term care benefits.
Wisconsin BadgerCare PlusCVSO (County Veterans Service Officer)
A trained professional employed at the county level who provides free assistance to veterans and their families in applying for federal VA benefits, state veterans benefits, and other programs. CVSOs are experts in navigating the VA claims process — they help veterans file initial claims, gather supporting evidence, submit appeals for denied claims, and apply for specific benefits including the VA Aid & Attendance pension, service-connected disability compensation, and VA health care enrollment. In the senior care context, a CVSO is often the single most valuable free resource for families exploring whether a veteran or surviving spouse qualifies for financial assistance with assisted living, memory care, or in-home care costs. Every Wisconsin county has a CVSO, and their services are free.
Find your CVSOFamily Care
Wisconsin's managed long-term care program for eligible seniors and adults with disabilities. Family Care provides a care team — including a care manager and a registered nurse — who assess needs, develop a care plan, and coordinate services. Covered services can include assisted living, personal care, home modifications, transportation, and adult day care. Both functional and financial eligibility screenings are required through your local ADRC.
WI Family CareFunctional Screen
A standardized assessment tool used by Wisconsin's ADRCs to determine whether a person meets the functional eligibility criteria for publicly funded long-term care programs like Family Care and IRIS. The screen evaluates the individual's ability to perform ADLs, need for supervision due to cognitive or behavioral issues, and overall level of functional impairment. This is distinct from a cognitive screening (like the MoCA) or a financial eligibility screen — the functional screen is specifically about what the person can and cannot do in daily life, and it is the gatekeeper for accessing Wisconsin's long-term care system. The screen must be completed before an application for Family Care or IRIS can move forward, and results determine both eligibility and the level of services the care plan will include. Contact your county ADRC to request a functional screen.
WI Functional Screen InfoIRIS (Include, Respect, I Self-Direct)
Wisconsin's self-directed long-term care program that gives eligible adults a personal budget to hire their own caregivers and purchase services directly, rather than going through a managed care organization like Family Care. IRIS participants have the freedom to choose who provides their care — including family members in some cases — and how their budget is spent. Both functional and financial eligibility screenings are required through your local ADRC.
WI IRIS ProgramLong-Term Care Ombudsman
An independent state-appointed advocate who investigates complaints, mediates disputes, and protects the rights of residents in nursing homes, assisted living communities, and other long-term care facilities. The ombudsman program is federally mandated under the Older Americans Act and operates in every state. Ombudsmen visit facilities regularly, often unannounced, and provide a confidential channel for residents and families to report concerns about care quality, abuse, neglect, financial exploitation, dietary issues, discharge disputes, or violations of resident rights. They do not work for the facility — they are independent advocates whose sole responsibility is protecting residents. Their services are free and confidential.
WI Ombudsman ProgramDementia & Memory Care
12 termsAlzheimer's Disease
The most common form of dementia, accounting for 60-80% of cases. Alzheimer's is a progressive neurodegenerative disease that destroys memory, thinking skills, and eventually the ability to carry out simple tasks. Early symptoms include difficulty remembering recent conversations or events; as the disease advances, personality changes, disorientation, and loss of bodily functions occur. While there is no cure, FDA-approved medications can temporarily slow the worsening of symptoms, and early diagnosis gives families time to plan care, finances, and legal matters while the person can still participate meaningfully.
Alzheimer's Association WIExit-Seeking Behavior
A common and potentially dangerous behavior in people with dementia where the person attempts to leave a safe environment — a memory care community, their home, or a family member's house — without awareness of the risks. Exit-seeking is distinct from simple wandering: it is often goal-directed (the person believes they need to go to work, pick up a child, or return to a former home) and can involve significant determination, including trying multiple doors, following staff or visitors, or becoming agitated when prevented from leaving. Memory care communities address exit-seeking through secured perimeters, alarmed doors, circular hallway designs that reduce frustration, and redirection techniques rather than physical restraint.
Frontotemporal Dementia (FTD)
A group of disorders caused by progressive nerve cell loss in the brain's frontal and temporal lobes — the areas behind the forehead and ears that control personality, behavior, and language. FTD tends to strike younger than other dementias, with most diagnoses occurring between ages 45 and 65. Unlike Alzheimer's, memory often remains intact in early stages; instead, the hallmark signs are dramatic personality changes, loss of inhibition, compulsive or socially inappropriate behavior, apathy, and language difficulties (trouble finding words, speaking, or understanding speech). Because these symptoms can resemble a midlife crisis, psychiatric condition, or marital problems, FTD is frequently misdiagnosed for years. There is no cure, but speech therapy, behavioral strategies, and medications can help manage specific symptoms. FTD is one of the four major dementia types — alongside Alzheimer's, Lewy body dementia, and vascular dementia — and understanding which type a person has is critical because each progresses differently and responds to different care approaches.
AFTD AssociationGEMS State Model
A six-stage framework developed by occupational therapist Teepa Snow as part of the Positive Approach to Care methodology. The GEMS model classifies cognitive abilities into six gem-based stages — Sapphire (normal aging), Diamond (routine and rigidity), Emerald (lost in a time period), Amber (sensory-based comfort seeking), Ruby (fine motor skill loss), and Pearl (late-stage dementia) — each with specific interaction strategies tailored to what the person can still do rather than what they have lost.
Teepa Snow PACLewy Body Dementia
The second most common type of progressive dementia after Alzheimer's, accounting for 5-15% of all dementia cases. Lewy body dementia (LBD) is caused by abnormal protein deposits called Lewy bodies that develop in nerve cells in the brain regions involved in thinking, memory, and movement. The condition is uniquely challenging because it shares symptoms with both Alzheimer's (memory loss, confusion) and Parkinson's disease (tremors, stiffness, slow movement, shuffling gait). Three hallmark features help distinguish LBD: vivid and well-formed visual hallucinations early in the disease course, fluctuating cognition where alertness and confusion vary dramatically from hour to hour or day to day, and REM sleep behavior disorder where the person physically acts out vivid dreams. People with LBD are also frequently extremely sensitive to antipsychotic medications — drugs commonly used for hallucinations in other conditions can cause severe worsening of movement symptoms, confusion, or even a life-threatening reaction called neuroleptic malignant syndrome. Because of this medication sensitivity, distinguishing Lewy body dementia from Alzheimer's is critical before any treatment decisions are made. Care focuses on a delicate balance of medications, environmental safety to prevent falls, and caregiver education about the fluctuating nature of symptoms.
LBDA AssociationMemory Box
A curated display of personal photographs, mementos, and familiar objects mounted outside each apartment door in a memory care community. Memory boxes help residents with dementia recognize their own room through visual familiarity rather than relying on impaired memory — a person may not remember their room number but will recognize their wedding photo or a favorite decorative item displayed in the box.
MoCA (Montreal Cognitive Assessment)
A widely-used 30-point screening tool that evaluates memory, attention, language, visuospatial skills, executive function, and orientation. Scores of 26 and above are considered within the normal range. The MoCA is more sensitive than the Mini-Mental State Exam (MMSE) for detecting mild cognitive impairment and early dementia. It takes approximately 10-15 minutes to administer and is often used by neurologists and geriatricians as part of a comprehensive cognitive evaluation.
MoCA Official SiteMontessori-Based Programming
An approach adapted from the Montessori educational philosophy that emphasizes dignity, meaningful engagement, and independence for people living with dementia. The method creates a prepared environment where residents with dementia can succeed at purposeful activities — such as setting tables, sorting objects, or gardening — based on their remaining strengths rather than being defined by what they have lost.
MDDA WebsiteSundowning
The increased confusion, agitation, restlessness, and sometimes aggressive behavior that many people with dementia experience in the late afternoon and evening hours. The phenomenon is believed to be related to changes in the brain's internal clock and circadian rhythm disruption. Good memory care communities manage sundowning with environmental adjustments — increasing lighting before dusk, reducing noise and activity in the late afternoon, and offering predictable calming routines — rather than defaulting to medication.
Teepa Snow Positive Approach to Care
An evidence-based dementia care methodology developed by occupational therapist Teepa Snow that teaches caregivers practical, hands-on techniques for connecting with people living with dementia. The approach is built around the GEMS state model and emphasizes understanding the person's remaining abilities, adapting communication and physical approach to match their cognitive state, and creating positive, meaningful interactions.
Teepa Snow WebsiteValidation Therapy
A communication method developed by social worker Naomi Feil that teaches caregivers to empathize with and validate the emotions of people with dementia rather than attempting to reorient them to reality. For example, if a resident with dementia asks to see their deceased mother, the Validation approach would explore the feelings behind the request rather than reminding them that their mother has passed away — which can trigger fresh grief each time. This approach reduces anxiety, builds trust, and maintains dignity.
Validation Therapy InstituteVascular Dementia
A type of dementia caused by reduced or blocked blood flow to the brain, often resulting from a major stroke or a series of small, often unnoticed mini-strokes (transient ischemic attacks). Unlike the gradual, steady decline typical of Alzheimer's disease, vascular dementia often progresses in a stepwise pattern — relatively stable periods interrupted by sudden drops in cognitive function following each vascular event. The specific symptoms depend entirely on which part of the brain was damaged: impaired judgment, difficulty planning and organizing, and slowed thinking are often more prominent than memory loss in the early stages, which distinguishes it from Alzheimer's. Physical symptoms such as weakness on one side of the body, slurred speech, or difficulty walking may also be present. Risk factors include high blood pressure, diabetes, high cholesterol, smoking, and atrial fibrillation — meaning that aggressive management of cardiovascular health is the most effective strategy for both prevention and slowing progression. Vascular dementia can also co-occur with Alzheimer's disease (called mixed dementia), which is more common than either condition alone in people over 80. Because each of the four major dementia types — Alzheimer's, Lewy body, frontotemporal, and vascular — progresses differently and responds to different care approaches, getting the correct diagnosis matters deeply for care planning.
American Stroke AssociationInsurance & Medicare
26 termsBenefit Period
For Original Medicare Part A skilled nursing coverage, a benefit period begins the day you are formally admitted as an inpatient and ends when you have not received inpatient care for 60 consecutive days. Medicare covers up to 100 days of skilled nursing per benefit period — not per year. You can have multiple benefit periods. Days 1-20 are covered at 100%; days 21-100 require a daily coinsurance.
Coinsurance
Your share of the cost for a covered healthcare service, calculated as a percentage or a fixed daily amount. For Medicare skilled nursing, the daily coinsurance is the amount you pay per day for days 21-100 after Medicare pays its portion. In 2026, this is approximately $209 per day — always confirm the current rate with Medicare.gov.
Conservatorship
A legal process in which a court appoints a responsible person or entity (the conservator) to manage the financial affairs and/or personal care of an adult who has been determined to be unable to manage their own affairs due to incapacity. The two main types are conservatorship of the person (managing personal care, medical decisions, and living arrangements) and conservatorship of the estate (managing finances, property, and assets). In Wisconsin, the term "guardianship" is more commonly used for personal care decisions, while "conservatorship" is sometimes used interchangeably or specifically for financial matters depending on the jurisdiction. The process requires a court hearing, medical evidence of incapacity, and ongoing court supervision. Conservatorship is typically a last resort when the person did not establish a durable power of attorney or healthcare proxy before becoming incapacitated, and it can be avoided entirely with proper advance planning including a durable power of attorney, healthcare power of attorney, and living will. The conservator has a fiduciary duty to act in the best interest of the protected person and must file regular accountings with the court.
Custodial Care
Non-medical help with daily personal tasks such as bathing, dressing, eating, using the bathroom, and moving around. Custodial care does not require skilled medical training — a home health aide, family member, or CNA can provide it. This is a critical distinction because Original Medicare does not cover custodial care when that is the only care needed, which is why assisted living and memory care are generally not covered by Medicare.
Daily Maximum
In a long-term care insurance policy, the most the policy will pay for care on a single day. For example, a policy with a $250 daily maximum will cover up to $250 per day in care costs, with any amount above that being the policyholder's responsibility. This is one of the key numbers to understand when evaluating whether a long-term care policy will meaningfully offset memory care or skilled nursing costs.
DNR (Do Not Resuscitate)
A medical order, usually written by a physician at the request of a patient or their healthcare agent, instructing healthcare providers not to perform cardiopulmonary resuscitation (CPR) if the patient's heart stops or they stop breathing. A DNR order is typically chosen by individuals with serious illness, advanced age, or frailty for whom CPR would be unlikely to result in meaningful recovery and might instead cause additional pain, broken ribs, or prolonged suffering in a state they would not want. In Wisconsin, a DNR order must be documented on the state's official DNR form or bracelet and is recognized by emergency medical services, hospitals, and nursing homes. A DNR is different from a living will: a living will is a legal document that expresses preferences, while a DNR is an active medical order that emergency responders must follow immediately. A DNR can be revoked at any time by the patient or their authorized decision-maker. Families should discuss DNR preferences before a crisis occurs, ensure the order is accessible in an emergency, and understand that a DNR does not mean "do not treat" — it specifically means do not attempt CPR; other treatments such as comfort care, pain management, and antibiotic treatment continue as desired.
Elder Law Attorney
An attorney who specializes in legal issues affecting seniors, including Medicaid planning, long-term care financing, estate planning, guardianship, and protecting assets while qualifying for public benefits. Elder law attorneys help families legally restructure finances to meet Medicaid asset limits while preserving as much of the senior's estate as possible — a process often called "spend down" planning. They also draft powers of attorney, advance directives, and help families navigate the intersection of care needs and legal rights.
Elimination Period
In a long-term care insurance policy, the waiting period — typically 30, 60, 90, or 180 days — between when care begins and when the policy starts paying benefits. During the elimination period, the policyholder pays for care out of pocket. A longer elimination period usually means lower premiums, but it also means a larger immediate financial obligation when care is needed.
Guardianship
In Wisconsin, a legal relationship established by a court in which a person (the guardian) is appointed to make personal, medical, and/or financial decisions for an adult who has been found incompetent by a court. Guardianship is a protective measure of last resort, used when an adult lacks the capacity to make or communicate responsible decisions about their personal care, medical treatment, or finances, and no less restrictive alternatives — such as a durable power of attorney, supported decision-making, or advance directives — are in place. The guardian's authority is limited to what the court specifically orders, and the court continues to supervise the guardianship. Wisconsin recognizes two types: guardianship of the person (decisions about living arrangements, medical care, and daily activities) and guardianship of the estate (decisions about property and finances). The process requires a formal court petition, a medical or psychological evaluation, a court hearing, and ongoing annual reporting. Guardianship can be avoided in most cases through advance planning with a durable power of attorney, healthcare power of attorney, and living will — which is why elder law attorneys strongly encourage every adult to complete these documents before any crisis occurs.
Inpatient
A patient who has been formally admitted to a hospital with a doctor's order. This distinction is critically important for Medicare skilled nursing coverage: only a qualifying inpatient hospital stay of at least three consecutive midnights (not counting the day of discharge) triggers Medicare Part A coverage for subsequent skilled nursing care. If you are in the hospital but not formally admitted — instead held under observation status — you are not considered an inpatient, and your days in the hospital do not count toward the three-day qualifying stay requirement.
Living Will
A legal document that specifies a person's wishes regarding medical treatment they would want — or refuse — if they become unable to communicate those wishes themselves due to illness, injury, or cognitive decline. A living will typically addresses decisions about life-sustaining treatments such as mechanical ventilation, artificial nutrition and hydration, dialysis, and CPR. In Wisconsin, the living will is one of two essential advance directive documents (the other being a Power of Attorney for Health Care, which names the person who will make decisions). A living will only takes effect when two physicians certify that the patient is in a persistent vegetative state or a terminal condition with no reasonable chance of recovery — it does not prevent treatment in situations where recovery is possible. The living will is distinct from a POLST: a living will is a legal document that guides future decision-making, while a POLST is a medical order that emergency providers must follow immediately. Every adult should have a living will, and it should be reviewed and updated periodically as health conditions and preferences change. Copies should be given to the healthcare agent, primary care physician, and any specialists involved in the person's care.
WI Advance DirectivesLong-Term Care Insurance
A private insurance policy that helps cover the cost of long-term care services — including assisted living, memory care, skilled nursing, and in-home care — that are not covered by Original Medicare or standard health insurance. Policies vary widely in what they cover, so it is essential to understand the benefit period, daily maximum, elimination period, and specifically whether memory care is covered.
ACL Long-Term Care InfoMedicaid
A joint federal and state health insurance program that covers medical and long-term care costs for eligible low-income individuals. In the context of senior care, Medicaid is critically important because — unlike Medicare — it can cover long-term custodial care in skilled nursing facilities and, through state programs like Wisconsin Family Care and IRIS, in assisted living and memory care settings. Eligibility is based on both functional need (requiring a level of care that meets the state's nursing home level of care criteria) and financial criteria (in 2026, the asset limit is generally $2,000 for an individual, with certain exempt assets including a primary home under specific conditions and one vehicle). Medicaid planning — legally restructuring assets to qualify — is a common reason families consult an elder law attorney.
Wisconsin MedicaidMedicare (Original Medicare)
The federal health insurance program primarily for Americans age 65 and older, administered by the Centers for Medicare & Medicaid Services (CMS). Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care — it is premium-free for most people who paid Medicare taxes while working. Part B covers doctor visits, outpatient care, preventive services, and durable medical equipment — it requires a monthly premium. In the senior living context, the single most important thing to understand about Original Medicare is what it does not cover: it does not pay for long-term custodial care in assisted living, memory care, or nursing homes when custodial care is the only care needed. It does cover up to 100 days of skilled nursing per benefit period after a qualifying inpatient hospital stay, but only for skilled medical care — not for help with bathing, dressing, or eating. Many families are shocked to discover this gap only after a crisis occurs. This is why long-term care insurance, Medicaid planning, VA benefits, and private pay are the primary funding sources for assisted living and memory care.
Medicare.govMedicare Advantage (Part C)
Private health plans approved by Medicare that provide Part A and Part B coverage, often with additional benefits like prescription drug coverage, dental, and vision. Medicare Advantage plans may have different rules for skilled nursing coverage than Original Medicare — different networks, different prior authorization requirements, and potentially different coverage limits. Always call the plan directly to verify skilled nursing coverage before admission.
Compare Medicare PlansMedicare Part A
Original Medicare's hospital insurance, which covers inpatient hospital stays, skilled nursing facility care (under specific conditions), hospice care, and some home health care. For skilled nursing, Part A covers up to 100 days per benefit period after a qualifying inpatient hospital stay of at least three consecutive midnights. Days 1-20 are covered in full; days 21-100 require a daily coinsurance.
Medicare SNF CoverageMedicare Part D
Original Medicare's prescription drug coverage, administered through private insurance plans approved by Medicare. Part D is optional but strongly recommended — even if you take no prescriptions today, delaying enrollment without creditable coverage (from an employer plan, for example) triggers a permanent late enrollment penalty added to your monthly premium for as long as you have Part D. Plans vary by formulary (the list of covered drugs), premium, deductible, and pharmacy network. Open enrollment runs annually from October 15 through December 7 for coverage starting January 1. For seniors comparing assisted living costs, prescription drug expenses are a significant line item — and Part D coverage gaps or high-tier medications can add hundreds per month. Medicare Advantage plans (Part C) often bundle Part D coverage, but Original Medicare enrollees must purchase a standalone Part D plan separately.
Medicare Part D PlansMedicare Savings Programs
Four federally funded state-administered programs that help low-income Medicare beneficiaries pay for Medicare premiums, deductibles, coinsurance, and copayments. The four tiers are: QMB (Qualified Medicare Beneficiary) — covers Part A and Part B premiums, deductibles, coinsurance, and copayments; SLMB (Specified Low-Income Medicare Beneficiary) — covers Part B premiums only; QI (Qualifying Individual) — covers Part B premiums only (first-come, first-served, must reapply annually); and QDWI (Qualified Disabled and Working Individuals) — covers Part A premiums for certain disabled working individuals under 65. In Wisconsin, Medicare Savings Programs are administered through BadgerCare Plus. Contact your local ADRC or Wisconsin DHS to determine eligibility and apply.
WI Medicare SavingsObservation Status
A hospital designation where a patient is held for monitoring and evaluation without being formally admitted as an inpatient. This is a common and costly trap for families: observation status does not count toward the three-midnight qualifying inpatient hospital stay required for Medicare to cover subsequent skilled nursing care. Always ask the hospital to confirm whether your loved one was formally admitted as an inpatient or is being held under observation.
POLST (Physician Orders for Life-Sustaining Treatment)
A medical order, signed by both a physician and the patient (or their legal representative), that translates a person's wishes about end-of-life care into actionable medical instructions. Unlike an advance directive or living will, which are legal documents that guide future decisions, a POLST is a medical order that emergency personnel and healthcare providers must follow immediately — it is the equivalent of a prescription for the care you want. A POLST covers specific treatment decisions including whether to attempt CPR, the level of medical intervention desired (comfort measures only, limited additional treatment, or full treatment), and whether artificial nutrition and hydration should be used. In Wisconsin, the POLST form is bright pink and is recognized statewide by emergency medical services, hospitals, nursing homes, and hospice providers. It is designed for people with serious illness or frailty who may die within the next year, not for healthy adults. A POLST does not replace an advance directive — it complements it by making the wishes expressed in the advance directive immediately actionable in a crisis. Every senior and their family should understand the difference between a living will (which states what you want), a healthcare power of attorney (who decides for you), and a POLST (what medical providers must do). The Wisconsin POLST form is available through the Wisconsin Medical Society and must be completed with a physician or advanced practice provider.
Wisconsin POLST FormPower of Attorney (POA)
A legal document that grants a designated person — called the agent or attorney-in-fact — the authority to make decisions on behalf of another person, the principal. For seniors, there are two essential types: a Durable Power of Attorney for Finances, which allows the agent to manage bank accounts, pay bills, handle investments, sell property, and sign contracts; and a Power of Attorney for Health Care (sometimes called a Health Care Proxy), which allows the agent to make medical decisions, access medical records, and communicate with doctors if the principal becomes incapacitated. The word "durable" is critical — it means the document remains valid even if the principal becomes mentally incapacitated. Without a properly executed POA, families may need to petition a court for guardianship, a process that can take months, cost thousands of dollars, and add enormous stress during an already difficult time. Every senior should have both documents in place before any health crisis occurs.
WI Power of Attorney FormsPrior Authorization
A requirement by a health insurance plan — common in Medicare Advantage and private insurance — that the plan must approve a specific medical service, medication, or facility admission before the patient receives it. In the skilled nursing context, Medicare Advantage plans frequently require prior authorization for nursing home admission, and failing to obtain it can result in denied claims and tens of thousands of dollars in personal liability. Original Medicare generally does not require prior authorization for skilled nursing, which is one of the key reasons families with a choice between Original Medicare and Medicare Advantage need to understand the differences before a skilled nursing event occurs.
Spend Down
The process of reducing a senior's countable assets to meet Medicaid's financial eligibility limits for long-term care coverage. In 2026, Wisconsin's asset limit for an individual is generally $2,000, though certain assets — including a primary home (with equity up to a state-specific limit) and one vehicle — are exempt. Spend down is not about hiding or giving away money (Medicaid has a five-year lookback period that penalizes improper transfers); it is about legally converting countable assets into exempt assets — for example, paying off a mortgage, making home modifications for accessibility, pre-paying funeral expenses, or purchasing an irrevocable burial trust. Because the rules are complex and state-specific, families navigating spend down should always work with an experienced elder law attorney.
State Survey
An unannounced, comprehensive inspection of a skilled nursing facility conducted by state health department surveyors on behalf of Medicare and Medicaid. Surveyors evaluate compliance with federal quality-of-care regulations across areas including resident rights, quality of life, nursing services, dietary services, infection control, and physical environment. Deficiencies are rated by scope and severity — from isolated incidents with no actual harm to widespread problems causing immediate jeopardy to resident health or safety. Survey results are public and published on Medicare's Care Compare website, where they contribute to the facility's overall star rating. When touring a skilled nursing facility, always ask to see the most recent survey report and pay close attention to any deficiencies classified as causing actual harm.
Supplemental Security Income (SSI)
A federal income supplement program administered by the Social Security Administration that provides monthly cash payments to seniors age 65 and older, as well as blind or disabled individuals, who have very limited income and financial resources. SSI is distinct from Social Security retirement benefits — it is a needs-based program funded by general tax revenues, not Social Security payroll taxes. In the senior care context, SSI eligibility often serves as a gateway to automatic Medicaid eligibility in Wisconsin and many other states. The monthly payment amount varies based on living situation and other income but is intended to help with basic needs like food, clothing, and shelter. Asset limits are strict (generally $2,000 for an individual).
Apply for SSIVA Aid & Attendance Benefit
A tax-free monthly monetary benefit for wartime veterans or their surviving spouses who require assistance with daily living activities such as bathing, dressing, eating, or using the bathroom. The benefit can be used to help pay for assisted living, memory care, in-home care, or adult day care. Eligibility requires meeting specific service, income, asset, and medical criteria. Unlike many VA benefits, Aid & Attendance does not require a service-connected disability.
VA Aid & AttendanceStaffing & Roles
11 termsCNA (Certified Nursing Assistant)
The hands-on caregivers who provide the majority of direct personal care in assisted living, memory care, and skilled nursing settings. CNAs assist residents with bathing, dressing, toileting, eating, and mobility under the supervision of a licensed nurse (RN or LPN). They complete a state-approved training program and competency exam, typically lasting 75-150 hours depending on state requirements.
Geriatric Care Manager
A professional — typically a licensed social worker, nurse, or gerontologist — who assesses a senior's physical, cognitive, and psychosocial needs and develops a coordinated care plan. Geriatric care managers serve as a single point of contact for families navigating complex care decisions: they conduct in-home assessments, recommend appropriate levels of care, identify and tour facilities, coordinate with medical providers, manage crisis interventions, and monitor ongoing care quality. They are especially valuable for families who live at a distance from their loved one or who are overwhelmed by the options and want an expert guide through the process.
Geriatrician
A board-certified physician who specializes in the medical care of older adults, typically age 65 and above. Unlike a primary care physician who treats patients of all ages, a geriatrician has advanced training in the complex, often overlapping health conditions that affect seniors — including polypharmacy (managing multiple medications and their interactions), cognitive decline, fall risk, frailty, and the interplay between physical health and quality of life. A geriatrician is often the best first stop for a comprehensive cognitive evaluation when dementia is suspected.
Home Health Agency
A licensed organization that provides skilled medical and therapeutic services in a senior's home or independent living apartment. Services typically include skilled nursing (wound care, medication management, IV therapy), physical therapy, occupational therapy, speech-language pathology, and home health aide assistance. Home health care is prescribed by a physician and is often covered by Medicare Part A or Part B for homebound patients who require skilled care. Many independent living communities have a preferred on-site home health agency that residents can contract with as their needs increase, allowing them to age in place without moving to a higher level of care.
LPN (Licensed Practical Nurse)
A licensed nurse who provides basic bedside care under the supervision of an RN or physician. LPNs monitor vital signs, change wound dressings, administer routine medications, collect samples for lab tests, and assist with personal care tasks. LPN training typically takes 12-18 months and leads to a diploma or certificate. In skilled nursing facilities, LPNs often serve as charge nurses on shifts, supervising CNAs and handling day-to-day clinical tasks.
Medical Director
The licensed physician responsible for overseeing the overall medical care delivered in a skilled nursing facility. The Medical Director sets clinical policies and protocols, reviews resident care plans, ensures regulatory compliance, and acts as a liaison between the facility and attending physicians. For residents with complex medical needs, having a Medical Director who rounds frequently — ideally daily — can make a meaningful difference in catching problems early and coordinating care across multiple specialists.
OT (Occupational Therapy)
Licensed therapists who help seniors regain or maintain the ability to perform daily living skills — dressing, bathing, grooming, meal preparation, and household management — after an illness, injury, or surgery. In a skilled nursing or rehabilitation setting, OTs also evaluate home safety, recommend adaptive equipment, and train family caregivers on safe transfer and self-care techniques.
PT (Physical Therapy)
Licensed therapists who help restore mobility, strength, balance, and coordination through targeted exercises, gait training, and manual therapy techniques. In a skilled nursing or rehabilitation setting, PT is often the most intensive therapy provided, focusing on helping seniors regain the ability to walk, transfer safely, and navigate stairs after a hospitalization, fall, or surgery.
RN (Registered Nurse)
A licensed nurse who has completed an accredited nursing program (associate or bachelor's degree) and passed the NCLEX-RN exam. RNs assess residents, develop and manage care plans, administer medications and treatments, supervise LPNs and CNAs, and serve as the clinical decision-maker on the floor. In skilled nursing, RN hours per resident per day is a key quality metric — the national average is approximately 0.65 hours, and facilities above 1.0 hours are considered well-staffed.
Senior Move Manager
A professional who specializes in helping older adults and their families manage the physical, logistical, and emotional aspects of downsizing and relocating to a senior living community. Senior Move Managers (SMMs) handle every phase: creating a detailed floor plan of the new residence, sorting and organizing decades of belongings, coordinating with movers and estate sale companies, packing and unpacking, and setting up the new apartment completely — often including hanging pictures, making the bed, and stocking the bathroom — so the senior walks into a fully prepared home. Most SMMs are members of the National Association of Senior Move Managers (NASMM) and follow a code of ethics that prioritizes the senior's dignity and autonomy. Families who work with an SMM report significantly lower stress, fewer family conflicts, and faster emotional adjustment for the senior.
NASMM DirectorySLP (Speech-Language Pathologist)
Licensed therapists who evaluate and treat communication, swallowing (dysphagia), and cognitive-communication disorders. In a skilled nursing or rehabilitation setting, SLPs help seniors who have difficulty speaking after a stroke, trouble swallowing food or liquids safely, or cognitive changes that affect communication. SLP intervention for swallowing disorders is critical for preventing aspiration pneumonia.